Purpose: Limited infrastructure, sparse resources, and challenging geography make delivering surgical care difficult in Solomon Islands. This retrospective study aims to quantify the number of diabetes-associated amputations in Solomon Islands and to describe the characteristics and clinical management of patients undergoing diabetes-associated limb amputation. Methodology: Researchers collected demographic and clinical data on patients who underwent diabetes-associated limb amputation at all surgical centers in Solomon Islands. Study sites included the National Referral Hospital and four provincial hospitals. Summary statistics are presented below. Results: Between 2018 and 2023, 402 adults underwent major limb amputation secondary to diabetes-associated infections. Surgeries included below-knee (N=305), above-knee (N=90), through-knee (N=3), below-elbow (N=3), and above-elbow amputation (N=1). Among patients with medical records (N=305), median age was 55 years (range: 22-84), 52.5% (N=160) were male, and 51.8% (N=158) had a previous amputation in the past 5 years. 97.4% (N=297) experienced delays in surgery with the mean wait time for amputation being 7.8 days (range: 0-86, STD:10 days). 32.8% (N=100) of patients waited more than 30 before seeking medical attention. Blood glucose levels were controlled in 1.2% (N=5) of patients during hospitalization. 9.8% (N=30) of patients died prior to discharge. Conclusion: The prevalence of uncontrolled blood sugar and delays in presentation and surgery likely contributed to morbidity and mortality in this cohort. Interventions should focus on strengthening diabetes prevention programs, increasing access to safe and timely surgery, and improving diabetic foot care services.